14847 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -
-i,131JI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER ,. V
I t AODRE55 /p�L _ APPLICATION & PERMIT 1 [A� }^( [A�7
MILLER A V BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I l V T'1
NWMER O/x/ �E/y(Q V PLAN CHECK VALIDATION
} 1 Ld C OTV. ELECTRIC PERMIT FEE
HONE O
UNTRACTOR'SUTLETS-SWITCHES-RECEP 10.00/1.00
.0 JI 1-04 xzealmt JILIC.N..50147qLIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
`
ADDRESS w n ,
WiTCOAKI'MCME PANELS.. 10.00 DATE OF APPLICATION
ARCRITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) - - 20.00
-' ENGINEER -
uc.No. - SIGNSTRANS. 3.00
ARCH,OR ENG. SPECIALCIRCUIT 5.00 PER MIT VALIDATION- '
zlv TEMP.METER OR POLE INS. . 40.00 /\
APPLICANT STs MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
002
F o 0LICENSIiU CONTRACTORS DECLARATION. .
< v W I hereby affirm that I am licensed under provisions of Chapteg9 .. ISSUANCE DATE-
H z (commencing with Section 7000)of Division 3 of the Business and
y¢ o BLDG. ELECT. I PLG. MECH.
H w i Professions Code, my license is in full force a feel. - ❑ ❑ '❑
z o W License P ss Lic.Number /�
O y H w Dale Contractor
a r f J D BUILDING PERMIT
r< ¢ OWNIi R-BUILDER DECLARATION
E a a u INFORMATION
w ; u N I hereby al firm that am exempt I'roni the Contractor's License MISC.- REFER TO ORD
HLOJ Law furthe following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE' ' 10.00 1}(µDAT10N $/FT.
u,y Code:Anycity orcounty which requires a permit to construct,alter, % w"/,�w
a p improve,demolish,or mpairany structure,prior to ifs issuance,also ELEC.CONTR. LIC.NO. ELEC. / (.Ey V -
1 n 0 ma. requires the applicant for such permit to file a signed statement that - TOTAL ERMIT TO
X m e, he is licensed pursuant to the provisions mine,Contractors License
HIa. Law(Chapter9(commencing with Section 7000)ofDivision 3 of(he L?,Q/O,� /H�Dw�,
f z ao Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT
toH the basis for the alleged exemption.Any violation ofSecfoG7031.5 STORIES TYPE CONSTR.
n ; .• by any applicant for a permit subjects the applicant to a civil penalty 00 ALTER-DRAIN -WATER IEA.) 5.
\ of not more than five hundred dollars(8500).): _
❑ 1,as owner of the property,or my employees with wages us BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,andlhe structure is nal OCC.GROUP RES.UNITS
intended or offered far sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 '
Code:The Contractor's License Law docs not apply to an owner of - .
property who builds or improves thereon,and who does Such werk FIXTURES,PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided(hat such improve-
ments are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,[he owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE ,
t prove for purpose of sale.)., INDUSTRIAL WASTE INTER. 30.00 . RES IND cont PB Other I,as owner ol'the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed'contractors to construct the project'(Sce. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. - 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under See. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner 'Date WATER SYSTEM - 5.00 ACC.DATE ACC FILE N0.
_. . WORKERS'COMPENSATION DECLARATION' WATER TREATING EQUIP. 5.00 ,
hereby affirm That I hove acerffi"IL,Rt'consent to self-insure,
or a certificate of Workers'Compensation Ins ru c or a 'ertificd ZONING ENG.SITE NO.
copy thereof(Sec,380 Lab.G.).
Policy No. mpany
❑ Car
co Is bereft rri
Z ❑ Cer y fl colt t e city inspee division. FIRE SPRINK ENERGY T-24
Applicant MISC.- - REFER TO ORD. Y ❑ N❑ Y ❑ N❑
CC .12TIFICA1 It OFF ' -ROM K4 S' .PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU - COMPEN ION NSURAN PLG.CONTR. - LiC.NO. PLG. -
?
Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y [:] N[]
hundred dollars($100)or less.)'
L) O 1 Certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
IL F mit is issued,1 shell not employ any person in any manner so as to
ad hcome subject to the Workers'Compensation Laws of California.
y Date Applicant - ALTER OR ADD TO MECH. 5.00 mBUILDING
} N NOTICE TO APPLICANT: If,atter taking[his Certificate of Ex.
? emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK ..
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10000C.F.M.) 4.00 -
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 100WC.RM.) 6.00 SEISMIC FEE W 6
I hereby affirm that Dere is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE)- - 4.00 -
information is correct. I agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER'COMP,(3 H.P.or 100,000 B.T,U.)' 6.00
hereby aulhorirc representatives of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection Purposes.
(We) a t save, i e fy and keep harmless the City of MISC.- REFER TO ORD.
CuPert
Elf liabi' j gments, costs and expenses which - CONST.TAX
t too way.ac 6 nst said City in cense uenc of the PERMIT ISSUANCE 10.00
Big this
per MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 6
nraiture o App ctor at
OFFICE COPY
I ,
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
. 14847
I
y ,I'. I CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
ate' '
'PERMIT EXPIRATION
JOB ADDRESS /O/d/ /'//LL��(-, �i/E UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER ' spyDo CONTRACTOR' C V. 1��6 ZZL--7Cik IS NOT STARTED WITHIN
INSPECTION - DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS,FROM .
'NOTE: LAST CALLED INSPECTION. .
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE' -� TO COMPLY WITH THE APPROVED PLANS AND CIN OF - ' PERMn,VAuuATION
CUPERTINO STANDARDS. a'
GARAGE SLABS - '•
e
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED J- 7,- $— I-
i
UNDERGROUND /SLAB .�• / -
PLUMBING' - — f�. /
l"2 -gam
ELECTRICAL - _ ISSUANCE DATE
MECHANICAL BLDG, �ELEct. PLG.- MECH.
_ ._ _ SIJ ❑ ❑ d
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDB I OR ATION DING PERMIT
WOOD FLOOR VALUATION $/FT.
PLUMBING - - � _ �
MECHANICAL
ELECTRICALPERMIT TO.
FRAMING '
INSULATION 'S r bmI CS TYPE CONSTR.
. . - OCC.GROUP RES.UNITS
dP,LA@E' OSUBFLOORUNTILABOVE.HASBEENSIGNED '
v� �• SO.FT FLOOR AREA TOTAL ACREAGE
_ , ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING / RES IND CON PB op.,
WAP.P6VINO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ `
ASSE550HS PARCEL NO
ROUGH SANA
PLUMBING - ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN.. PLUMBING ENERGY -
MECHANICAL - MECH.ENERGY
ELECTRICAL . 'f'-�' �$�f' BUILDING ENERGY ACC DATE acc.FILE No.
'- - -FRAMING ELECT.FINAL TEST
_ INSULATION PLUMBING ZONING ENG:SITE NO.
GAS TEST GAS -
MECHANICAL - FIRESPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NE] ❑ "❑
FLOOD ZONE A,L U C.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR. - FIRE DEPT.
Y,❑ N
'�❑ Y YL
-16' GRADE - FEE SUMMARY • -,e
EXTERIOR'LATH BUILDING
INTERIOR LATH TEMPORARY AP ROVALS' BUILDING
SCRATCH COATELECTRIC PLAN CHECK'
GASFEE
aNO,T'APE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' ' SEISMIC FEE
OCCUPANCYOF•BUI LOING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE. FOR'INSPECTION BY PHON ING252-4505, ELECTRIC
Iw—
ONE WORKING DAY BEFORE REQUIRED INSPECTION'. PLUMBING
00 PLEASE GIVE JOB ADDRESS WHEN PHONING. .
Z — SEE PERMIT FOR EXPIRATION DATE"—
MECHANICAL
IMPORTANT! coNsr:TAX,
PLEASE READ REVERSE SIDE'BEFORE TOTAL
CALLING FOR FINAL.INSPECTION.
OFFICE COPY